Context While medical journals strive to ensure accuracy and the acknowledgment
of limitations in articles, press releases may not reflect these efforts.

Methods Telephone interviews conducted in January 2001 with press officers at
9 prominent medical journals and analysis of press releases (n = 127) about
research articles for the 6 issues of each journal preceding the interviews.

Results Seven of the 9 journals routinely issue releases; in each case, the
editor with the press office selects articles based on perceived newsworthiness
and releases are written by press officers trained in communications. Journals
have general guidelines (eg, length) but no standards for acknowledging limitations
or for data presentation. Editorial input varies from none to intense. Of
the 127 releases analyzed, 29 (23%) noted study limitations and 83 (65%) reported
main effects using numbers; 58 reported differences between study groups and
of these, 26 (55%) provided the corresponding base rate, the format least
prone to exaggeration. Industry funding was noted in only 22% of 23 studies
receiving such funding.

Conclusions Press releases do not routinely highlight study limitations or the role
of industry funding. Data are often presented using formats that may exaggerate
the perceived importance of findings.

Medical journals work hard to ensure that articles fairly represent
study findings and to acknowledge important limitations, work that may be
undone by the time research findings reach the news media. Medical journal
press releases are perhaps the most direct way that journals communicate with
the media. Although releases provide an opportunity to help journalists get
stories "right," there has been little scrutiny of the release process or
quality. Herein, we describe the press release process at several high-profile
medical journals, and review recent releases to learn how study findings are
presented and whether limitations and potential conflicts of interest are
acknowledged.

METHODS

We studied press releases at 9 high-profile journals (Table 1) selected for their professional influence (ie, they all
rank at the top of the Institute for Scientific Information's impact factor
listings1), and because they are frequently
cited by the news media.

In January 2001 we conducted 15-minute telephone interviews with press
officers (identified via the journal Web sites, or by asking to speak with
"the person dealing with the press"). All journals contacted agreed to participate.
The interview covered policy (Are releases issued? If so, for which articles?
How are the articles chosen?) and production (Who writes releases? Are there
explicit guidelines? How are study authors or journal editors involved?).
Interview responses were entered into a database and tabulated.

Content

We obtained all press releases (and source articles and corresponding
editorials) for the 6 issues of each journal preceding the interviews either
from the journal Web sites or from EurekAlert! (http://www.eurekalert.org), an electronic archive of releases for science writers. After excluding
15 releases about organizational policy or guideline announcements, we identified
127 releases about original research.

We created a simple coding scheme to assess press release quality. Quality
measures relevant to all releases included whether study results were quantified,
and whether limitations were mentioned. We also had quality measures relevant
to specific release subgroups. For those presenting differences between study
groups, we report whether the corresponding base rate was provided (eg, a
measure of absolute frequency expressed as proportions, counts [numerator/denominator],
or rates). For articles funded by industry (ie, those noting pharmaceutical
or technology company funding), we report whether this support was mentioned
in the release. For articles with accompanying editorials, we report whether
the release noted the existence of the editorial and industry funding of editorialists.

The study authors jointly coded each release. A research assistant,
blinded to the purpose of the study, also coded each release; agreement between
the study author's coding and the blinded coder was "almost perfect" (overall κ
= 0.9).2

RESULTS

Press Release Process

Seven of the 9 study journals routinely issue press releases (New England Journal of Medicine and Annals of Surgery do not). All 7 use the same basic approach: the journal
editor or press office selects articles on the basis of perceived newsworthiness,
and releases are written by press officers typically trained in communications
(3 had science degrees). Each journal provides these officers with general
guidance about length, but not with standards for acknowledging limitations
or for data presentation. Editorial input varies: at one extreme the journal
editors are uninvolved (eg, Circulation); at the
other, the manuscript editor works with the study author and press office
to edit the release which is then approved by the editor-in-chief (eg, Journal of the National Cancer Institute).

Press Release Content

The 7 journals issued 127 press releases (and published 544 articles)
during the study period. The number and length of releases varied widely.
For example, Circulation generated the fewest releases
(10), but these were the longest (typically 27 sentences long); in contrast, Pediatrics generated the most releases (25), but these
were among the shortest (typically 4 sentences long).

Only 23% (29/127) of press releases included any mention of study limitations;
65% (83/127) quantified study results. Fifty-eight reported on differences
between study groups or presented ratio measures (eg, relative risk or odds
ratios in a cohort study); of these, 32 (55%) included the corresponding base
rate, a format recognized as least likely to generate exaggerated perceptions
of the magnitude of findings.3- 5

Twenty-three studies were industry funded, yet only 22% of the corresponding
releases noted this support. Thirty-six studies were accompanied by an editorial;
most releases (29/36) noted the editorial (typically providing context, validating
findings, or raising concerns). Five editorialists were industry supported
or reported direct financial conflicts (eg, holding a relevant patent); none
of these disclosures were noted in the press releases.

COMMENT

A number of authors have criticized the accuracy and balance of the
news media in reporting on medical science.3,4,6
As a direct means of communication between medical journals and the media,
press releases provide an opportunity for journals to influence how the research
is translated into news. Our findings suggest journals could make more of
this opportunity; the press releases we studied frequently presented data
in exaggerated formats, and failed to highlight study limitations or conflicts
of interest.

Our study has several limitations. First, we examined only a small number
of journals and a limited sample of releases. Nonetheless, the journals included
are among the most influential in the world; they possibly set standards for
many others. Second, our criteria for release quality are subjective. While
other measures might be chosen, we believe ours capture a minimal quality
standard: releases should quantify findings in a balanced way, and note limitations
and conflicts of interest. Finally, we did not assess the relationship between
releases and media coverage. Releases do seem to draw journalists' attention
and increase the chance that an article receives press coverage.7
However, most journalists say they do not rely solely on the release for information,
but go to the article.8

The most direct way to improve the quality of journal press releases
lies in enhanced editorial oversight of the process. Editors might develop
presentation standards for releases analogous to the structured abstract format
used by many journals, and might include a section putting results in context
(eg, are the results consistent with other studies, is there a corresponding
editorial), a limitations section, and a statement about potential conflicts
of interest. Moreover, quantitative results might be reported in a standardized
way, eg, in a table using absolute event rates for intervention and control
groups.

The public9 and many physicians10 often learn about new medical research through the
news media, rather than medical journals. We think that journals can and should
do more to enhance the quality of medical reporting.